Evaluation of Rate of Depression and Anxiety in Patients Presenting for Hydrogen Breath Testing

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Introduction: Symptoms of small intestinal bacterial overgrowth (SIBO) overlap with many functional GI disorders. It is known that patients with IBS may also suffer from depression and anxiety. It is unclear if patients with SIBO have a predisposition towards depression or anxiety.

Methods: This was a single-center, prospective study conducted between May 2016 and May 2017. All patients referred for hydrogen breath testing were consented prior to completion of a survey which included CES-D (Center for Epidemiological studies-depression), GAD-7 (Generalized anxiety disorder-7), as well as Rome III criteria for IBS. Hydrogen breath tests were interpreted by a single physician (MS) based on the most recent American College of Gastroenterology guidelines. Patients with a history of SIBO were excluded. The study was approved by the Loyola University Medical Center IRB.

Results: Overall, 71 patients who completed hydrogen breath testing agreed to participate. The mean age was 54, and there were more female participants than males (73%>27%). The survey for IBS based on Rome III criteria was completed by 70 patients, and 44 met criteria. Among 44 patients who met Rome III criteria for IBS, 15 (34%) had depression and 19 (43%) had anxiety. Among the 50 patients who tested positive for SIBO 17 (34%) were depressed, and 18 (36%) had anxiety. Among the 21 patients who tested negative for SIBO, 5 (24%) were depressed and 10 (48%) had anxiety. Approximately 62% of patients met Rome III criteria for IBS regardless of the results of the breath test (31/50 with positive breath test and 13/21 with negative breath test). There was no statistical significant relationship between the presence of IBS and SIBO on Fisher's exact test (p=1.0).

Conclusion: Patients who present for hydrogen breath testing for evaluation of SIBO have similar rates of depression and anxiety as patients with IBS, regardless of the results of the breath test. This may be due to an overlap between these disorders. Treating patients with these disorders may require a multidisciplinary approach.